A 7-year-old African-Canadian male is brought to your office with a 1-day history of purulent, crusted eyelashes in the morning, and red eye. There is no history of visual change, foreign body, or injury. The child is otherwise in good health and has normal developmental milestones. No fever or respiratory distress is noted. A clinical diagnosis of bacterial conjunctivitis is made. The mother is anxious to keep the child in school.
Which one of the following would be the most appropriate time for the child to return to school?
Correct Answer A: Once therapy is initiated, children with bacterial conjunctivitis should be allowed to remain in school. Careful hand hygiene is important, however, and behavior must be appropriate to maintain adequate hygiene. No specific length of treatment or evidence of clinical response is required before returning to school.
The mother of a newborn has agreed to your suggestion that she breastfeed for at least the first 6 months of her daughter’s life. Before being discharged from the hospital, she asks you to clarify some advice she received from friends about the storage and handling of expressed breast milk.
Which one of the following would be accurate advice?
Correct Answer A:
With many nursing mothers returning to work it is frequently necessary to shift lactation and feeding schedules using techniques such as expressing milk with pumps and storing the excess. Human breast milk may safely be stored up to 4 hours at room temperature, up to 48h in the refrigerator, and up to 3 months when frozen. When frozen, it should be thawed slowly to preserve nutritious proteins and should not be refrozen. Human breast milk naturally separates and can easily be re-emulsified by shaking. Exposure to human milk is not an occupational hazard under CCOHS standards.
An obese 11-year-old boy with diabetes mellitus is admitted to the hospital because of severe ketoacidosis and cardiovascular collapse.
Which of the following electrolyte deficits would most likely cause death in this patient?
Correct Answer D:
Diabetics in DKA are at serious risk for profound hypokalemia, a potentially fatal condition. The hypokalemia results from both profound dehydration and from an intracellular return of potassium to cells after the requirement to buffer the acidosis has passed. During acidosis there is an exchange of potassium for hydrogen with hydrogen moving intra-cellularly to be buffered.
A 9-year-old girl presents to the emergency department. She appears acutely ill and complains of headache, nausea, vomiting, and abdominal pain. She appears moderately dehydrated.
Which of the following does not support the diagnosis of diabetic ketoacidosis?
Correct Answer B:
The serum blood glucose is grossly elevated in diabetic ketoacidosis (DKA) because the absence of insulin in the bloodstream makes glucose unable to enter the cells.
A. Although not specific for DKA, hyperpnea is indicative of the acidosis associated with DKA.
C. Polyuria, polydipsia, and fatigue are the result of the osmotic diuresis seen with hyperglycemia.
D. Ketoacidosis is a hallmark of DKA
E. Ketones are seen in the urine during DKA, or any other catabolic state where proteins are being used as a major energy source.
What is the immediate goal in the treatment of new onset insulin dependent diabetes mellitus (IDDM) and diabetic ketoacidosis (DKA)?
Correct Answer C:
The immediate goal in treating DKA is to restore intravascular volume, paying attention to electrolyte losses associated with DKA, especially potassium and phosphate. Intravenous administration of insulin follows to reverse the catabolic state and the ketosis.
A. The serum glucose is elevated in DKA and supplemental administration of dextrose is not helpful.
B. Sodium bicarbonate is usually not necessary to correct the acidosis and is certainly not the immediate treatment indicated.
D. Antibiotic administration should be initiated only if an infection has been identified.
E. Screening siblings is not indicated and is certainly not addressed as an immediate issue when a patient presents in DKA.
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